Clinical analysis of different types of neonatal sepsis: a multi-center retrospective study / 中国新生儿科杂志

Objective:To study the clinical characteristics of different types of neonatal sepsis.Methods:From January 2012 to December 2019, neonates with confirmed sepsis from 5 neonatal centers of central-south China were reviewed. The neonates were assigned into early-onset sepsis (EOS) and late-onset sepsis (LOS) group, and the latter was further subgrouped into hospital-acquired LOS (hLOS) group and community-acquired LOS (cLOS) group. The etiological and clinical characteristics were analyzed. SPSS 26.0 was used for statistical analysis.Results:A total of 580 neonates were enrolled, including 286 (49.3%) in the EOS group and 294 (50.7%) in the LOS group. In LOS group, 147 were in hLOS group and 147 were in cLOS group. The gestational age and birth weight of hLOS group were significantly lower than the other two groups [(32.7±3.6) weeks vs. (37.1±3.7) weeks and (37.7±3.0) weeks, (1 810±717) g vs. (2 837±865) g and (3 024±710) g] ( P<0.05). The common pathogens in EOS and cLOS groups were coagulase-negative staphylococci and Escherichia coli, while Klebsiella pneumoniae was common in hLOS group. Carbapenems usage in the hLOS group was significantly higher than the other two groups [62.6% vs. 28.7% and 16.2%] ( P<0.05). Antibiotics duration in the hLOS group was longer than the other two groups [19 (14, 27) d vs. 15 (12, 20) d and 14 (12, 19) d] ( P<0.05). Conclusions:The clinical characteristics of neonatal sepsis vary among different types of infections, and it is necessary to establish appropriate prevention, control, diagnosis and treatment protocols.

Clinical analysis of adrenal incidentaloma in children / 中华实用儿科临床杂志

Objective:To explore the clinical characteristics and treatment regimens of adrenal incidentaloma (AI) in children.Methods:Clinical data of 38 children with AI treated in the Department of Urology, Children′s Hospital of Nanjing Medical University from December 2016 to October 2021 were retrospectively analyzed.A total of 38 children were divided into neonatal group and non-neonatal group according to their age at first diagnosis.The neonatal group had 7 males and 9 females patients, of whom 7 cases were detected with AI during prenatal examinations, 9 cases were diagnosed postnatally.Four children in neonatal group had AI in the left adrenal gland and 12 cases in the right, with the maximum diameter of tumor (MDT) ranging from 16-48 mm.In the non-neonatal group, there were 14 males and 8 females patients aged 7 months and 1 day to 12 years and 1 month, and the MDT was 29-131 mm.Paired t test was used to compare the age and MDT of benign and malignant tumors. Results:In the neonatal group, 3 patients were surgically treated, with 2 cases and 1 case of neuroblastoma and teratoma confirmed by postoperative histology, respectively.The remaining 13 patients in the neonatal group were followed up for 1-31 months, with 8 cases and 5 cases of complete remission and significantly decreased tumor volume, respectively.In the non-neonatal group, there were 3, 9 and 10 patients received open biopsy, laparoscopic adrenalectomy, and open adrenalectomy, respectively.Of these 22 surgically treated cases, 8 cases had a benign lesion, including ganglioneuroma ( n=4), adrenocortical adenoma ( n=1), adrenal cyst ( n=1), teratoma ( n=1), and pheochromocytoma ( n=1); while 14 cases had a malignant lesion, including neuroblastoma ( n=8), ganglioneuroblastoma ( n=5), and adrenocortical carcinoma ( n=1). The mean age of patients with malignant tumors was significantly younger than those with benign tumors[(38.94±35.44) months vs.(95.89±41.43) months, t=3.63, P=0.001]. The mean MDT in malignant tumors was significantly longer than that of benign tumors[(64.43±25.20) mm vs.(41.44±15.66) mm, t=2.45, P=0.023]. Conclusions:AI in children has a high risk of malignancy.Therefore, more detailed examinations are needed to detect tumor markers and endocrinological parameters, and imaging tests such as non-contrast and CT examination should be performed as early as possible.AI in children is predominantly neuroblastic tumors.For non-neonatal patients, surgery should be performed as early as possible.For AI found in the neonatal period and prenatal examination, expectant management is feasible if the tumor is relatively small and limited to the adrenal gland without distant metastases.

Analysis of Clinical Data and Construction of A Diagnostic Prediction Model for Metabolic Syndrome after Single-Center Hematopoietic Stem Cell Transplantation / 中国实验血液学杂志

UNLABELLED@#AbstractObjective: To analysis the clinical data of patients after single-center hematopoietic stem cell transplantation (HSCT) and construct a predictive model for metabolic syndrome (MS) diagnosis.@*METHODS@#Ninety-three hematology patients who underwent HSCT at the First Hospital of Lanzhou University from July 2015 to September 2022 were selected to collect basic data, transplantation status and postoperative data, the clinical characteristics of patients with and without MS after transplantation were compared and analyzed. Logistic regression model was used to analyze the influence fators of MS after transplantation, and a predictive model of HSCT-MS diagnosis was constructed under the influence of independent influence factors. The model was evaluated using the ceceiver operating characteristic curve (ROC curve).@*RESULTS@#Metabolic syndrome occurred in 36 of 93 HSCT patients and did not occur in 57. Compared with non-HSCT-MS group, HSCT-MS had significantly higher fasting blood glucose (FBG) levels before transplantation, shorter course before transplantation, and higher bilirubin levels after transplantation (P<0.05). The statistically significant clinical indicators were subjected to multi-factor logistic regression analysis, and the results showed that pre-transplant high FBG, pre-transplant short disease course and post-transplant high bilirubin were independent influence factors for HSCT-MS. The standard error of predicting the occurrence of HSCT-MS based on the clinical model was 0.048, the area under the curve AUC=0.776, 95% CI :0.683-0.869, the optimal threshold was 0.58 based on the Jorden index at maximum, the sensitivity was 0.694, and the specificity was 0.772, which has certain accuracy.@*CONCLUSION@#A clinical prediction model for HSCT-MS based on logistic regression analysis is constructed through the analysis of clinical data, which has certain clinical value.

Clinical analysis of immunotherapy rechallenge in advanced gastric cancer / 中华肿瘤杂志

Objective: To evaluate the efficacy and influencing factors of programmed death protein 1 (PD-1) monoclonal antibody rechallenge therapy in advanced gastric cancer (GC). Methods: The clinical data of patients with advanced GC who were treated with anti-PD-1 rechallenge in Henan Cancer Hospital from January 2020 to December 2021 were collected retrospectively. The progression-free survival (PFS) was defined as the time from the first or second used of anti-PD-1 treatment to the date of disease progression or the last follow-up, named PFS(1) and PFS(2), respectively. Kaplan-Meier method and Log rank test were used for survival analysis, Cox proportional hazard model was used to analyze the influencing factors. Results: A total of 60 patients with anti-PD-1 rechallenge therapy were collected, the median follow-up time was 12.2 months. The median progression-free survival (PFS(2)) of anti-PD-1 rechallenge therapy was 2.9 months, the objective response rate (ORR) was 16.7%, and the disease control rate (DCR) was 55.0%. The median PFS(2) of the first and second anti-PD-1 identical and different rechallenge treatment was 3.5 months and 1.9 months (P=0.007) respectively. The median PFS(2) of positive PD-L1 expression in rechallenge therapy was 3.4 months, ORR was 22.7%, and DCR was 63.6%; the median PFS(2) was 4.5 months, ORR was 27.3%, and DCR was 54.5% in patients with median PFS(1)≥6 months. Multivariate analysis showed that peritoneal metastasis was independently associated with anti-PD-1 rechallenge therapy with PFS(2) (HR=2.327, 95% CI, 1.066-5.082, P=0.034). The incidence of adverse reactions in grade 1-2 and grade 3-4 of anti-PD-1 rechallenge therapy was 83.3%, and 35.0%, respectively, and the safety was controllable. Conclusion: Rechallenge therapy with anti-PD-1 is a feasible treatment in advanced GC, but the screening of suitable population for rechallenge therapy still needs prospective data analysis and verification.

Neonatal-onset protein C deficiency: case report and literature review / 中国新生儿科杂志

Objective:To study the clinical features, diagnosis, treatment and genetic characteristics of neonatal-onset protein C deficiency (PCD).Methods:The clinical data of a newborn patient with severe PCD admitted to our neonatal department was reviewed. Databases including CNKI, Wanfang Database, CMB, VIP database, PubMed, Embase and SCI database were searched using" infantile", " neonate ", "newborn", "protein C deficiency" and "purpura fulminans" as key words. Published cases of PCD were analyzed.Results:The patient was a full-term female infant who developed multiple symptoms within 2 days after birth. The symptoms included thrombocytopenia, intracranial hemorrhage, purpura fulminans (PF), disseminated intravascular coagulation (DIC), celiac hemorrhage, hypertension, portal and iliac vein thrombosis, purulent meningitis and retinal detachment. Protein C activity was less than 10%. Genetic tests showed compound heterozygous mutations c.314G>T (p.c105f) of paternal origin and c.1218G>A (p.m406i) of maternal origin in PROC gene. According to ACMG guidelines, the mutations were strongly suspected pathogenic variants and consistent with an autosomal recessive (AR) inheritance pattern. The patient was discharged after 6 weeks of treatment at parents' request of withdrawal. A total of 25 articles on 29 patients with relatively complete clinical data were retrieved, including 18 males and 11 females. 4 patients were preterm and 25 full-term. 28 patients showed symptoms within 7 days after birth. The common clinical features were cutaneous PF and splanchnic thrombi. 22 cases documented protein C activity and ranged from 0 to 25%. 16 patients had PROC gene abnormalities and compound heterozygous mutations were found in 10 patients. Among the 22 patients with prognostic data, 11 died (9 within 3 months after birth), the remaining survivors suffered from sequelae including severe intellectual motor development disorder, epilepsy and blindness.Conclusions:The main clinical manifestations of neonatal-onset PCD include PF, DIC, multi-organ hemorrhage and thrombus. The disease is acute and severe, with rapid progression, poor prognosis and high fatality rate. Protein C activity and PROC gene testing may help establish the diagnosis.

Analysis of clinical features in children with McCune-Albright syndrome / 中华实用儿科临床杂志

Objective:To summarize and analyze the clinical features of McCune-Albright syndrome (MAS) in 26 children, to improve the understanding of MAS diagnosis and treatment, and to achieve early clinical diagnosis of MAS.Methods:The clinical data of 26 children with MAS treated in Department of Pediatrics, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2011 to June 2021 were retrospectively analyzed.Their clinical characteristics were summarized and studied. t-test, Mann- Whitney U test, χ 2 test or Fisher′ s exact probability method was used for comparison between groups. Results:(1) Among the 26 MAS patients enrolled, there were 22 females and 4 males.The average onset age of female and male patients was (5.87±2.94) years old and (7.48±3.36) years old, respectively.(2) In female patients, there were 7 cases with the typical triad and 15 cases with the atypical triad.(3) Female patients had the first symptom of vaginal bleeding (8/22) and breast development (14/22). Among the 4 male children, 1 case had " fracture" and 3 cases " lagged behind their peers in height" at the first visit.(4) Compared with the breast development group, the vaginal bleeding group had an earlier onset age[(4.06±1.88) years old vs.(7.82±1.82) years old] ( t=5.023, P<0.001), earlier bone maturation[(1.26±0.07) vs.(1.09±0.13)] ( t=2.933, P<0.05), a greatly lowered predicted adult height[(-2.16±0.98) SDS vs.(-0.96±1.09) SDS]( t=1.352, P<0.05), a lower blood phosphorus level[(1.41±0.14) nmol/L vs.(1.67±0.24) nmol/L] ( t=1.941, P<0.05), and a significantly elevated alkaline phosphatase level[339(313, 656) U/L vs.243(205, 452) U/L] ( U=1.000, P<0.05). All patients (8 cases) in the vaginal bleeding group had fibrous dysplasia of bone.(5) Ten patients progressed to central precocious puberty (CPP). They showed an older average age of onset[(7.27±2.69)years old vs.(4.69±2.68)years old] ( U=44.000, P<0.05), significantly earlier bone maturation at diagnosis[(1.23±0.11) vs.(1.01±0.13)] ( t=1.834, P<0.05), and a lower predicted adult height[(152.00±4.62) cm vs.(162.10±6.91) cm] ( t=3.805, P<0.05), compared with those who did not progress to CPP.(6) Eleven children developed polyostotic fibrous dysplasia of bone, and most common type (8 cases) was polyostotic fibrous dysplasia of bone, primarily at lower limb bones and skulls.(7) Of the 26 children, 20 cases had scattered Café au lait pigments on the skin.The Café au lait pigmented skin lesions in 35% (7/20) cases crossed the midline. Conclusions:With complicated clinical manifestations, MAS is more common and occurs earlier in girls than boys.It is difficult to clinically diagnose MAS in boys due to the insidious onset and atypical symptoms.Female MAS patients with vaginal bleeding as the first symptom usually have an early age of onset, advanced bone age and lower predicted adult height, so they should be monitored and evaluated clinically.Vaginal bleeding is significantly associated with polyostotic fiber dysplasia of bone in MAS patients.Therefore, it is recommended that patients with vaginal bleeding should undergo a routine bone single-photon emission computed tomography scan.This helps understand the situation of occult fiber dysplasia of bone.Patients with later diagnosis and advanced bone age should be aware of the possibility of progression to CPP.

The clinicopathological characteristics and therapeutic analysis of renal oncocytoma / 中华泌尿外科杂志

Objective:To discuss the clinical and pathological features of the patients with renal oncocytoma.Methods:Making a retrospective analysis of the clinical data of 35 patients with renal oncocytoma who were admitted to the department of urology in the First affiliated Hospital of China Medical University from January 2013 to August 2020, discussing their clinical features, pathological characteristics, treatment and prognosis. The age range of the 35 patients was 35-79 years, with an average age of (59.0±11.3) years, there were 15 males and 20 females. The tumors of the 35 patients were unilateral, concluded 22 cases on the left side and 13 cases on the right side.Among the 35 patients, the tumors of 7 cases located in the upper pole, 14 in the middle pole, and 14 in the lower pole. At the time of admission, 5 patients complained with flank pain, 3 patients had gross hematuria, and the other patients were found during physical examination or examination due to other diseases. In the imaging examination, there were 33 cases of ultrasound data, including 18 cases of hypoechoic, 10 cases of hyperechoic, 3 cases of isoechoic and 2 cases of mixed echo. The data of CT were collected in 30 cases. The tumors showed isointense or slightly hypointense on plain scan, after enhancement, it showed low enhancement with clear boundary to the renal parenchyma and 12 patients had typical central stellate scar sign. All patients accepted surgical treatment, including 23 cases of retroperitoneal laparoscopic surgery and 12 cases of open surgery, but only 12 cases had partial nephrectomy.Results:The tumors were incised after the operation, the range of the tumors’diameter was 1.3-14.0 cm, with an average of (4.0±2.3) cm. The color of the cross-section was tawny in 14 cases, mahogany in 19 cases and 2 cases of other colors. The typical features of tumor cell under microscope were arranged in nests, alveolar or tubular shapes, the cells were round or polygonal.The cell size was uniform, the cytoplasm was rich in eosinophilic granules, the nuclei was deeply stained and the nucleoli was small. There are 9 indicators reach to 20 cases in immunohistochemical stain, and the positive rates of each indicator are respectively EMA 100.0%(23/23), E-cadherin 100.0%(20/20), CK 96.2%(25/26), CD117 95.5%(21/22), p504S(AMACR)35.0%(7/20), CD10 33.3%(9/27), CK7 31.0%(9/29), Vimentin 17.2%(5/29), Ki-67(0/28). Thirty-five patients were followed up after surgery, 4 patients were lost to follow-up, and the follow-up time of the other 31 patients ranged from 7 to 90 months, with an average of (46.9±25.0) months. All patients had a good prognosis without recurrence or metastasis. Among them, 3 patients had mild renal insufficiency in a short time after operation, and they have all recovered. Three patients with gross hematuria before the operation disappeared after the operation. In 5 patients with low back pain, only two patients felt significant improvement, and the other three still felt intermittent episodes of dull lumbar pain.Conclusions:Renal oncocytoma is a relatively rare benign tumor of the kidney. Because of the lack of effective diagnostic methods, it is difficult to differentiate from renal malignant tumors preoperatively. Pathological results are the golden standard for the diagnosis and differential diagnosis of renal oncocytoma. The main treatment of renal oncocytoma is surgery, and after surgery, the patient's prognosis is good, but renal oncocytoma has the possibility of recurrence and metastasis, regular follow-up and surveillance are still required.

Neonatal hyperthyroidism: clinical analysis of 7 cases / 中国新生儿科杂志

Objective:To study the clinical features of neonatal hyperthyroidism.Methods:From September 2013 to September 2020, clinical data of neonates with hyperthyroidism admitted to the neonatal intense care unit of our hospital were retrospectively collected and analyzed.Results:A total of 7 neonates were included. The average gestation age was (35.8±2.3) weeks with 5 cases had GA<37 weeks. The median age of diagnostic was 16 d (7~18 d). The common clinical manifestations included tachycardia, irritability, low-grade fever, hyperhidrosis, bulimia, poor weight gain, diarrhea and jaundice. The levels of serum free triiodothyronine (FT 3) and thyroxine (FT 4) were elevated in all 7 cases and thyroid stimulating hormone (TSH) were decreased. The Doppler ultrasound of thyroid gland in two neonates revealed enlarged thyroid gland with abundant blood flow. All 7 mothers had hyperthyroidism with 4 mothers provided the history of hyperthyroidism and the other 3 were also confirmed after their infants were diagnosed. All 7 infants were treated with anti-thyroid drugs (ATD) and 2 were additionally given β-blockers to control heart rate. The median ATD duration was 40 d (7~58 d). 2 cases (both preterm infants) had slight decrease in FT 4 during medication. FT 4 of all 7 cases returned to normal before TSH. Conclusions:Neonatal hyperthyroidism has various and nonspecific clinical manifestations. Early diagnosis and timely treatment are important to prevent short-term and long-term adverse outcomes. Whether their mothers provide definite history of thyroid disorder or not, the thyroid function of the suspected neonates should be carefully monitored.

Clinical analysis of 10 cases of Bacillus cereus sepsis in premature infants / 中国新生儿科杂志

Objective:To study the clinical features, diagnosis and treatment of Bacillus cereus sepsis in premature infants.Methods:From February 2011 to February 2021, 10 cases of Bacillus cereus sepsis in premature infants admitted to the Department of Neonatology of our hospital were retrospectively analyzed.Results:The 10 cases of premature infants with Bacillus cereus sepsis included 5 males and 5 females, with gestational age 27 +2~35 +2 weeks, birth weight 940~2 430 g and the age of onset 7~35 days. At the beginning, all the infants showed lethargy and recurrent apnea as the onset symptoms. 8 cases had gray color skin, 7 cases had fever, 7 cases experienced septic shock, 5 cases had neonatal seizures and 4 cases showed abdominal distension. 7 cases were complicated with purulent meningitis and 3 cases with necrotizing enterocolitis. 9 cases had significantly decreased white blood cells and platelets and significantly increased C-reactive protein and procalcitonin at the onset. Among the 7 cases of purulent meningitis, 5 cases had multiple encephalomalacia. During follow-up of all the infants, 4 cases died, 3 cases cured and 3 cases survived with severe neurological sequelae. Conclusions:Bacillus cereus sepsis is a serious infectious disease for premature infants with acute onset, rapid progress and high mortality. Complication of purulent meningitis and serious neurological sequelae are common.

Programa de maestría para profesionales vinculados al análisis clínico / Master program for professionals linked to clinical analysis

RESUMEN El objetivo de la investigación de la cual deriva el presente texto estuvo encaminado a elaborar una propuesta de programa de maestría para los profesionales de la salud vinculados al análisis clínico, desde las tecnologías del diagnóstico en laboratorio. Se realizó un estudio descriptivo transversal en el Centro de Inmunología y Productos Biológicos de la Universidad de Ciencias Médicas de Camagüey, en el período comprendido de enero a marzo de 2019. De los métodos empíricos fueron empleados la técnica de discusión grupal y la encuesta aplicada a egresados y jefes de los servicios asistenciales. Se concluye que se elabora una propuesta de programa de maestría para los profesionales de la salud vinculados al análisis clínico como respuesta a la necesidad e interés por elevar los niveles de competencia y desempeño profesional e investigativo de estos desde las tecnologías del diagnóstico en laboratorio.

ABSTRACT The objective of the research was to develop a proposal for a master's program for health professionals linked to clinical analysis from laboratory diagnostic technologies. A descriptive cross-sectional study was carried out at the Center for Immunology and Biological Products of the University of Medical Sciences of Camagüey, in the period from January to March 2019. From the empirical methods, the group discussion technique was used, and the survey applied to graduates and heads of healthcare services. It is concluded that a master's program proposal is prepared for health professionals linked to clinical analysis in response to the need and interest in raising the levels of competence and professional and investigative performance of these from the technologies of laboratory diagnosis.

Clinical analysis of 252 patients with tuberculous peritonitis in Wuhu area / 中华临床感染病杂志

Objective:To analyze the clinical features of tuberculous peritonitis (TBP).Methods:The clinical data of 252 TBP patients admitted to three hospitals in Wuhu area from January 2014 to June 2020 were retrospectively analyzed, and the clinical characteristics of TBP patients of different genders and ages were compared. SPSS 26.0 software was used to analyze the data.Results:Among 252 TBP patients, 130 were males (51.6%) and 122 were females (48.4%). History of abdominal surgery, abdominal masses, reproductive disorders, genital tuberculosis, and delay in diagnosis were more common in female patients (all P<0.01); while fever, cough/sputum expectoration, intestinal tuberculosis and active tuberculosis were more common in male patients (all P<0.01). The proportion of adenosine deaminase in ascites (ADA) ≥35 U/L, strong positive tuberculin test or T-cell spot test in middle-aged and elderly patients was lower than that in young patients ( P<0.01), but there was no significant difference between different genders. Compared with young patients, middle-aged and elderly patients had a low complete response rate, a high proportion of irregular medications, a high incidence of gastrointestinal reactions, liver damage and overall adverse reactions (all P<0.05). Conclusion:Female patients with TBP have fewer symptoms of systemic tuberculosis and high rate of delay in diagnosis, and are prone to complicated with reproductive tuberculosis. In middle-aged and elderly patients with TBP, the sensitivity of ADA and tuberculosis tests is decreased, and the anti-tuberculosis therapy is less effective. The study indicates that the clinical diagnosis and treatment of TBP should be optimized based on the gender and age of patients.

A clinical study on 17 patients with liver perivascular epithelioid cell tumors / 中华肝胆外科杂志

Objective:To study the clinical manifestations and prognosis of patients with liver perivascular epithelioid cell tumor (PEComa).Methods:The clinical manifestations, imaging findings, pathological features, treatment and prognosis of 17 patients with liver PEComa managed in Shenzhen People's Hospital from September 2002 to January 2020 were retrospectively analysed.Results:The patient age of onset of liver PEComa was 22 to 54 years (average 34.8 years). There were 13 females and 4 males. 82%(14/17) of patients presented with no significant symptoms. 15/17 had solitary tumors. The diagnostic rate using preoperative B-ultrasound, CT and MRI was low. Postoperative pathological studies showed the tumor cells were mainly epithelioid cells with hyaline or eosinophilic cytoplasm. There were abundant blood vessels in the tumor tissues. Adipose tissues were also seen. Immunohistochemistry showed both HMB45 and Melan-A positivities to arrive at the diagnosis. All patients were treated with surgical resection. There were no recurrence, metastasis, or death on follow-up.Conclusion:Hepatic PEComa occurred more frequently in young women and it had no specific clinical manifestations. Except for a small number of tumors with adipose tissue detected on preoperative imagings, this tumor was difficult to diagnose, or even be suspected on preoperative imagings. Pathological examination combined with immunohistochemistry after surgery established the diagnosis. Surgery resulted in good prognosis.

Clinical analysis of recurrent Kawasaki disease in children / 中国小儿急救医学

Objective:To provide a theoretical basis for diagnosing and treating recurrent Kawasaki disease based on data analysis of clinical symptoms.Methods:Data analysis of children with recurrent Kawasaki disease admitted to Beijing Children′s Hospital of Capital Medical University from January 2016 to December 2019 was conducted, including comparisons of the initial onset and the recurrence on patients′ clinical features, auxiliary examination and treatment.Results:During the four-year scale, 3 041 children with Kawasaki disease were admitted to the department of Cardiology.The recurrence data involved 65 children[male∶female 3.1∶1, average aged(2.42 ± 2.04) years]. First, children′s fever duration was(5.66 ± 2.37) days in recurrence data, significantly shorter than that of their initial onset.The recurrence data also reported a lower incidence of rash and limb changes, together with respiratory and gastrointestinal symptoms.Then, 19 cases out of the 65 children got coronary artery lesion(CAL) at their initial onset.A relief of CAL was reported from 15 children when the disease recurred, along with 11 new-reported CAL cases.Intravenous immunoglobulin(IVIG) refractory Kawasaki disease cases accounted for nine at the initial onset and 12 at the recurrent onset, respectively.Five IVIG refractory recurrent cases reported significant relief after 2 g/kg IVIG treatment.Conclusion:The recurrent Kawasaki disease in children usually occurs among children under three years old, within the first year after the initial onset.Most of the recurrent cases report a shorter fever duration and less typical clinical symptoms than their first onset.In some cases, IVIG treatment showed effects initially but failed to work when the disease recurred.Therefore, glucocorticoid or infliximab should be considered for further treatment.

Clinical study of 23 cases with pneumocystis pneumonia after allogeneic hematopoietic stem cell transplantation / 中华急诊医学杂志

Objective:To analyze the risk factors,clinical characteristics and prognosis of the pneumocystis pneumonia(PCP) that is one of the severe pulmonary complications after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:The clinical features,laboratory data,treatment and outcomes of patients with PCP after allo-HSCT in our hospital from January,2016 to January,2021 were retrospectively collected and analyzed.Results:Twenty three cases who met the clinical diagnostic criteria of PCP were enrolled. The median time of diagnosed as PCP after transplantation was 221 days. The computed tomography (CT) of chest indicated diffuse ground glass opacity.The median of β-1,3-D glucan consentration was 894.25 ng/L, and 91.3% of the cases were over 60 ng/L.The lymphocyte count in 60.9% cases was lower than 1×10 9/L;CD4 +T lymphocyte count in 65.2% of patients was less than 200/μL. Pneumocytis sequences of mNGS were positive in all 21 cases.15 patients were complicated with mixed infection.All patients were treated with TMP-SMX,18 patients were cured and 5 patients died. Conclusions:Patients with PCP after allo-HSCT progresses rapidly, and which is usually with multiple infections. Serum β-1,3-D glucan concentration increase contributes to the diagnosis of PCP.And mNGS in alveolar lavage fluid is highly sensitive to Pneumocystis, which helps patients get treatment in time, so as to reduce mortality.Patients with respiratory failure progressing to a need for mechanical ventilation and high flow oxygen inhalation suggest a poor prognosis.

Multidrug-resistant Escherichia coli isolated from a dog with a history of urolithiasis: case report / Escherichia coli multirresistente isolada de cão com histórico de urolitíase: relato de caso

Bacterial resistance is a reality in both human and veterinary health, it limits the therapeutic arsenal and raises the costs of the patient's treatment. A dog with signs of cystitis received treatment with 5mg/kg enrofloxacin at three consecutive times, with low effectiveness. The presence of urethral uroliths was identified and urohydropulsion was done. The animal presented a new obstruction, for which a cystotomy was performed, but continued with signs of infection. Uroculture and antimicrobial susceptibility test were then performed. Escherichia coli was identified, which was resistant to 13 antibiotics, being sensitive only to piperacillin-tazobactam and amikacin. In the screening test for ß-lactamase, the production of ESßL was detected. The qPCR indicated the presence of the bla CTXm, bla DHA, bla OXA, bla IMP, bla TEM, bla GIM, bla SIM, bla SPM and bla SME genes, which may lead to a phenotypic resistance profile for ampicillin, amoxicillin-clavulanate, aztreonam, cefepime cefoxitin, cefuroxime, ceftazidime, ceftriaxone, imipenem, and piperacillin-tazobactam. This case reaffirms the value that laboratory analysis adds to the diagnosis and treatment of cystitis and urolithiasis, which can define the direction of evolution of the prognosis and the speed at which the patient's health will be restored.(AU)

A resistência bacteriana aos antibióticos é uma realidade, tanto na saúde humana quanto veterinária, limita o arsenal terapêutico e eleva os custos relacionados ao tratamento do paciente. Um cão, com sinais de cistite, recebeu tratamento com enrofloxacina, na dose de 5mg/kg, em três momentos seguidos, com baixa efetividade. Identificou-se presença de urólitos uretrais e foi feita uro-hidropropulsão. O animal apresentou nova obstrução, para a qual foi realizada uma cistotomia, mas continuou com sinais de infecção. Realizou-se, então, urocultura e teste de antibiograma. Foi identificada Escherichia coli, que se mostrou resistente a 13 antibióticos, sendo sensível somente à piperacilina-tazobactam e amicacina. No teste de triagem para ß-lactamase, detectou-se a produção de ESßL. A qPCR indicou presença dos genes blaCTXm, blaDHA, blaOXA, blaIMP, blaTEM, blaGIM, blaSIM, blaSPM e blaSME, que podem conduzir um perfil fenotípico de resistência para ampicilina, amoxicilina-ácido clavulânico, aztreonam, cefepima, cefoxitina, cefuroxima, ceftazidima, ceftriaxona, imipenem, piperacilina-tazobactam. Este caso reafirma o valor que a análise laboratorial agrega ao diagnóstico e tratamento da cistite e da urolitíase, podendo definir o sentido de evolução do prognóstico e a velocidade em que a saúde do paciente será restabelecia.(AU)

Nonconformities in clinical laboratories in Macapá, Amapá, Brazil, based on the RDC no. 302/2005/Anvisa / Não conformidades em laboratórios clínicos de Macapá, Amapá, Brasil, com base na RDC nº 302/2005/Anvisa

ABSTRACT Introduction: Clinical analysis laboratories are health care facilities that provide resources for outpatient and/or emergency diagnoses; they are regulated in Brazil by the Resolution of the Collegiate Board of Directors (RDC) no. 302, of October 13, 2005, of the Brazilian National Agency of Sanitary Surveillance (Anvisa). Objective: The aim of this study was to perform a normative evaluation in clinical analysis laboratories, based on RDC no. 302, of October 13, 2005. Material and method: This is a cross-sectional and descriptive study. Twelve clinical laboratories participated in the study. The data were obtained through a structured questionnaire and answered by the technical leaders of the participating laboratories, in the municipality of Macapá, Amapá, Brazil. Results: The average nonconformity found among the participants was 9.64%, which allowed an overall evaluation among them as satisfactory, in relation to the minimum requirements demanded by the standardization recommended by Anvisa. When the participants were analyzed individually, there was a variation from 4.82% to 21.69% of the nonconformities index. Other studies agree with the results, however there is disagreement in a research carried out in Porto Alegre, Rio Grande do Sul, Brazil, possibly due to the fact that the laboratories present in this study do not have a quality management system in their processes. Conclusion: Laboratories 2, 3, 4, 6, 9, 11, and 12 were rated as satisfactory. Laboratories 1, 5, 7, 8 and 10 were rated as partially satisfactory. No laboratories were rated as unsatisfactory.

RESUMEN Introducción: Los laboratorios clínicos son establecimientos de salud que ofrecen recursos para diagnósticos ambulatorios y/o de emergencia; son regulados en Brasil por la resolución del Directorio Colegiado (RDC) nº 302, de 13 de octubre de 2005, de la Agencia Nacional de Vigilancia Sanitaria (Anvisa). Objetivo: Este trabajo tuvo como objetivo efectuar una evaluación normativa en laboratorios clínicos, teniendo como base la RDC nº 302, de 13 de octubre de 2005. Material y método: Estudio transversal y descriptivo, con la participación de 12 laboratorios clínicos. Los datos se obtuvieron mediante cuestionario estructurado contestado por los responsables técnicos de los laboratorios participantes, en el municipio de Macapá, Amapá, Brasil. Resultados: La media de no conformidades entre los participantes fue de 9,64%, lo que permitió una evaluación general entre ellos como satisfactorios, con respecto a los requisitos mínimos exigidos por la Anvisa. Cuando los participantes fueron evaluados individualmente, hubo variación de 4,82% hasta 21,69% en el índice de no conformidades. Otros estudios presentaron resultados concordantes; sin embargo, hay desacuerdo en una investigación realizada en Porto Alegre, Rio Grande do Sul, Brasil, posiblemente porque los laboratorios participantes en ese estudio no tienen un sistema de gestión de calidad en sus procesos. Conclusión: Los laboratorios 2, 3, 4, 6, 9, 11 y 12 fueron evaluados como satisfactorios; los laboratorios 1, 5, 7, 8 y 10, como parcialmente satisfactorios. Ningún laboratorio fue evaluado como insatisfactorio.

RESUMO Introdução: Os laboratórios de análises clínicas são estabelecimentos de saúde que oferecem recursos aos diagnósticos ambulatoriais e/ou emergenciais; são regulamentados no Brasil pela Resolução da Diretoria Colegiada (RDC) nº 302, de 13 de outubro de 2005, da Agência Nacional de Vigilância Sanitária (Anvisa). Objetivo: Este trabalho teve como objetivo realizar uma avaliação normativa em laboratórios de análises clínicas, tendo como base a RDC nº 302, de 13 de outubro de 2005. Material e método: Estudo transversal e descritivo, com a participação de 12 laboratórios clínicos. Os dados foram obtidos por meio de questionário estruturado respondido pelos responsáveis técnicos dos laboratórios participantes, no município de Macapá, Amapá, Brasil. Resultados: A média de não conformidade encontrada entre os participantes foi de 9,64%, o que permitiu uma avaliação geral entre eles como satisfatórios, em relação aos requisitos mínimos exigidos pela normatização preconizada pela Anvisa. Quando os participantes foram avaliados individualmente, houve variação de 4,82% a 21,69% no índice de não conformidades. Outros estudos apresentam resultados concordantes; contudo, há discordância em uma pesquisa realizada em Porto Alegre, Rio Grande do Sul, Brasil, possivelmente pelo fato de os laboratórios presentes neste estudo não terem um sistema de gestão de qualidade nos seus processos. Conclusão: Os laboratórios 2, 3, 4, 6, 9, 11 e 12 foram avaliados como satisfatórios; os laboratórios 1, 5, 7, 8 e 10, como parcialmente satisfatórios. Nenhum laboratório foi avaliado como insatisfatório.

Analyses of the clinical features of 13 corona virus disease 2019 non-survivors / 解放军医学杂志

Objective To investigate the clinical features of 13 fatal cases of corona virus disease 2019 (COVID-19). Methods The clinical data of 13 patients who died of COVID-19 in Central Theater General Hospital, China, between January 4, 2020, and February 24, 2020, were analyzed retrospectively. The data reviewed included clinical manifestations, laboratory test results, radiographic features and dinical treatment plan. The cellular immune function, the expression of inflammatory factors, and lactate level in deceased patients at different stages of the disease were analyzed. Results Of those who died, the patients consisted of 10 men and 3 women. The age of those who died was (74±19) years, and 10(76.9%) patients were over 70 years old. For the patients who died, 9 presented with underlying diseases, 6(46.2%) of whom had more than 2 diseases. On admission, the chest computed tomography (CT) for 8 patients (61.5%) mainly showed multiple patchy ground-glass opacities. When the disease progressed, the ground-glass opacities rapidly developed into diffuse lesions in both lungs. The lymphocyte and CD3+, CD4+, and CD8+ T lymphocyte counts in the peripheral blood of 13 patients were significantly lower than normal levels and decreased more substantially during the disease course based on the levels when admitted (P<0.01). Additionally, the interleukin (IL)-6, D-dimer, C-reactive protein (CRP), lactic acid levels gradually increased, and most peaked before death. The cause of death for most patients was acute respiratory distress syndrome (ARDS) with type I respiratory failure. Three patients eventually developed multiorgan deficiency syndrome (MODS). Conclusions The risk factors of death for COVID-19 patients included older men, more underlying diseases, poor cellular immune function and over-expression of inflammatory factors. The main cause of death in patients with COVID-19 was ARDS, which led to respiratory failure and MODS.

Outcomes of 33 patients with anaplastic large cell lymphoma treated after hematopoietic stem cell transplantation / 中华血液学杂志

Objective@#To explore the efficacy and prognostic factors of hematopoietic stem cell transplantation (HSCT) for the treatment of patients with anaplastic large cell lymphoma (ALCL) .@*Methods@#The clinical records of 33 ALCL patients after HSCT were collected and analyzed retrospectively to evaluate the rates of overall survival (OS) and recurrence after autologous (auto-HSCT) and allogeneic HSCT (allo-HSCT) and the factors influencing prognosis.@*Results@#The median-age of this cohort of 33 ALCL cases at diagnosis was 31 (12-57) years old with a male/female ratio of 23/10, 24 cases (72.7%) were ALK+ and 9 ones (27.3%) ALK-. Of them, 25 patients (19 ALK+ and 6 ALK-) underwent auto-HSCT and 8 cases (5 ALK+ and 3ALK-) allo-HSCT with a median follow-up of 18.7 (4.0-150.0) months. Disease states before HSCT were as follows: only 6 patients achieved CR status and received auto-HSCT, 16 patients achieved PR (14 cases by auto-HSCT and 2 ones allo-HSCT) , the rest 11 cases were refractory/relapse (5 cases by auto-HSCT and 6 ones allo-HSCT) . There were 7 cases died of disease progression (5 after auto-HSCT and 2 allo-HSCT) and 5 cases treatment-related mortality (TRM) (2 after auto-HSCT and 3 allo-HSCT) , TRM of two groups were 8.0% and 37.5%, respectively. Both the median progression-free survival (PFS) and OS were 15 months after auto-HSCT, the median PFS and OS after allo-HSCT were 3.7 (1.0-90.0) and 4.6 (1.0-90.0) months, respectively. There was no statistically significant difference in terms of survival curves between the two groups (OS and PFS, P=0.247 and P=0.317) . The 2-year OS rates in auto-HSCT and allo-HSCT groups were 72% and 50%, respectively. The 5-year OS rates in auto-HSCT and allo-HSCT groups were 36% and 25%, respectively.@*Conclusion@#ALCL treated by chemotherapy produced high rates of overall and complete responses. Chemotherapy followed by auto-HSCT remained to be good choice for patients with poor prognostic factors. High-risk patients should be considered more beneficial from allo-HSCT.

Discussion on the treatment of 106 cases of Kaposiform hemagioendothelioma / 中华整形外科杂志

Objective@#To compare the curative effect of non-surgical treatment, early operation and advanced operation on the Kaposiform hemagioendothelioma (KHE). To explore the optimal treatment for KHE.@*Methods@#The 106 cases of KHE patients admitted by our hospital from January 2004 to December 2016 were selected as the study subjects. The age is the minimum 1d and the maximum 43 years, median age 94.5 d. According to different treatment methods, they were divided into non-surgical treatment and surgical treatment: according to the onset of the disease and the day of the operation, the early operation was performed less than three months since the onset of the disease, and the advanced operation more than 3 months. Efficacy evaluation criteria: The recovery meant that the tumor disappeared or mostly disappeared, the platelets returned to normal, and there was no recurrence more than half a year after treatment. " Effective" indicated that tumors were shrunken significantly and the platelet counting rose significantly. " Ineffective" indicated that the tumor was not shrunken or continued to increase and platelet counting did not rise or continued to decrease.The three groups of patients were followed up, and the efficacy of the three groups after treatment and the changes of platelet counting before and after treatment on day 1, 7 and 14 were compared. The two groups of early and late treatment were compared for operative and postoperative conditions.@*Results@#All patients were followed up for 6-23 months, 24 cases were effective, 12 cases were ineffective, and 5 cases died. After 7 days of treatment, the platelet counting of the three groups were 68 (31, 157)×109/L in the non-surgical treatment group, (294.75±150.59)×109/L in the early operation group, (221.48±148.71)×109/L in the late operation group, with statistical significance (P < 0.05). After 14 days of treatment, the platelet counting of the three groups were 78 (25.51, 54.5) in the non-surgical treatment group, 281 (234, 356)×109/L in the early operation group, and in the late operation group (219.67±140.95)×109/L, with statistical significance (P < 0.05). After at least half a year of follow-up, the total effective rate of clinical efficacy in the three groups was the non-surgical treatment group 62.07%, the early operation group 96.34% and the late operation group 81.82%; the difference was statistically significant between two groups (P < 0.05); There was significant difference between the early operation group and the late operation group in the amount of bleeding and operation time, the time of platelet counting and the total hospitalization time (P< 0.05).@*Conclusions@#Early surgical treatment of Kaposiform hemangioendothelioma is superior to late-operative and non-surgical treatment.Surgical treatment will be the preferred option for treatment of Kaposiform hemangioendothelioma, and examinations should be operated to potential patients for early diagnosis.

Clinical analysis of retinopathy of prematurity in preterm infants with very low birth weight / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the clinical characteristics of retinopathy of prematurity(ROP)in preterm infants with very low birth weight. <p>METHODS: A retrospective analysis was made of 3 121 premature infants who were admitted to the ophthalmic clinic and neonatal department of our hospital from December 2009 to June 2018 and underwent fundus examination. There were 1 862 males and 1 259 females. Among them, there were 400 premature infants with very low birth mass whose body mass was less than 1 500g. 191 males and 209 females. To compare the detection rate of ROP, gestational age, gender ratio, diagnosis time of ROP, severity of ROP and prevalence of other eye diseases, among different birth quality groups in preterm infants with extremely low birth mass.<p>RESULTS: In this study, 3 121 premature infants were screened, and the ROP detection rate was 8.2%(255/3 121). There were 400 premature infants with very low birth mass with a body mass less than 1 500g, ROP detection rate was 23.8%(95/400), stage 1-2 lesions that do not require treatment were 93.7%(89/95), pre-threshold and threshold lesions were 3.2%(3/95), stage 4-5 lesions were 3.2%(3/95). ROP detection rates of birth weight(g)<1 000, 1 000-1 499, ≥1 500, were: 25.0%, 23.7%, 5.9%, respectively. There were statistically significant differences in gestational age, ROP diagnostic time, between different birth weight groups(<i>P</i><0.001). There were significant differences in the severity of ROP among the groups with birth weight <1 000g, 1 000-1 499g and ≥ 1 500g. But, there was no significant difference in the severity of ROP between the group with birth weight 1 000-1 499g and the group with birth weight ≥1 500g(<i>P</i>>0.05). There was no statistical difference in the incidence of other eye diseases in different birth weight groups(<i>P</i>>0.05).<p>CONCLUSION: The lower of birth weight, with the higher of incidence of ROP. The severity of ROP in preterm infants with birth weight <1 000g was significantly higher than that of preterm infants with birth weight≥1 000g. Ophthalmology should combine obstetrics and neonatology to reduce the incidence of very low birth weight premature infants, and improve the compliance of screening and follow-up of retinopathy of very low birth weight premature infants, which is an important way to reduce the blindness caused by ROP.